When working with medical billing for insurance companies there is a great deal of confusion , about the Medical Billing Terminology used, as well as the correct procedures and practices.

One important thing to know about is the form.

The CMS-1500 form, also known as the Healthcare Financing Administration (HCFA), and the Professional Paper Claim Form, is used for reimbursement from various government insurance plans including Medicare, Medicaid and Tricare.

Although it was developed by The Centers for Medicare and Medicaid (CMS), it has become the standard form used by all insurance carriers.

Typically it is what physicians and clinical practitioners use to submit claims for professional services, and hence is very important to the process of getting paid.

Who Can Bill Claims using the CMS-1500 form?

Any non-institutional provider and supplier can use the CMS-1500 for billing medical claims. this includes:

– Physician services

– Physician assistants

– Nurse practitioners

– Clinical nurse specialists

– Nurse midwives

– Certified registered nurse anesthetists

– Clinical psychologists

– Clinical social workers

– Home dialysis supplies and equipment

– Ambulance services

– Clinical diagnostic laboratory services

When submitting the CMS 1500 form, it is important to note that some payers accept the photocopied black-and-white versions of the medical claims. However the best process is to submit the original red-and-white version.

Depending on the insurance payer, when the original claim form is not used, the claim may not scan into their system properly creating a delay or denial in payment.